According to the National Mental Health Survey 2016, 1 in 20 Indians suffer from severe depression. The rate of depression is higher among Indian females than males. This is similar to global trend, women are at higher risk for developing depression than males. Although there is research to support these gender differences, there are very few psychological studies which explore factors that are specific to Indian culture that could contribute to high risk for depression among Indian women. One major concern that I foresee as a clinical psychologist is that our social milieu does not put value on expression of negative emotions, which leads to bottling up feelings inside and even deny the existence of negative feelings. In extreme forms, one becomes numb to the feelings themselves, either negative or positive.
Another major challenge with seeking support for depression is lack of understanding what is depression and how it manifests. Depression is a clinical condition defined by the International Classification of Diseases (ICD 10) as someone experiencing low energy, interest, attention along with sleep difficulties, low mood, and suicidal ideation. However, a phenomenological experience of depression varies from one individual to the other. Some are likely to somaticize their psychological condition and report more health concerns and some may report problems in their environment such as financial stress or relationship difficulties than psychological distress. It’s easier to externalize the cause of depression, which saves them from looking inwards to look for solutions to their problems. Indian women are likely to express more physical symptoms under stressful life events than disturbed psychological states. This is due to lack psychological perspective on health problems. Our culture allows for expression of physical complaints as those conditions are taken more seriously by family members than psychological distress. Similarly, the medical model for treatment of depression is becoming more accepted than psychological therapy in our culture.
The causes for depression are understood from a complex interactional pattern between biological and psychosocial factors such as family stress, insecurity, or past trauma. For some, experiencing a negative life event such as a divorce may trigger cascade of emotional turmoil but may not necessarily lead to clinical depression. For another, even in absence of any negative life event may put them in deep states of depressive darkness. And for most, there could be a biological disposition due to family history of depression along with challenging life events. Therefore, both medical and psychological treatment is needed in some cases to successfully treat depression.
Therapy provides safe space for clients to vent feelings which one cannot do in society due to stigma attached. Friends and family members, despite their good intentions, may not be equipped to provide an empathetic and non-judgmental listening ear required to help someone suffering from depression. Since women are likely to internalize stress and feel guilty for their problems, they may engage in unhealthy coping styles such as ruminating over negative events, over-working to avoid feelings, or displacing one’s frustration on another which further may strain their relationships. Learning how to cope with challenging life experiences and negative feelings, with the help of a professional counsellor, can instill healthier thinking patterns to overcome stressful life situations. Identification and diagnosis by a professional is the first step that is needed before seeking appropriate treatment methods. One cheap and effective method for early diagnosis is to make it mandatory for all health service institutions to offer free depression screening tests, in various languages, for the people to recognize this condition. It’s important to remember that depression can be treated and an individual does not have to suffer alone.